Effects of menopausal hormone therapy on uterine myoma in menopausal women.

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Abstract

The aim of the present study is to evaluate the long term effects of estrogen-progestogen therapy (EPT) on uterine myomas volume in postmenopausal women.

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Uterine leiomyomas (fibroids or myomas), benign tumours of the human uterus, are the single most common indication for hysterectomy. They are clinically apparent in up to 25% of women and cause significant morbidity, including prolonged or heavy menstrual bleeding, pelvic pressure or pain, and, in rare cases, reproductive dysfunction. Thus, both the economic cost and the effect on quality of life are substantial. Surgery has been the mainstay of fibroid treatment, and various minimally invasive procedures have been developed in addition to hysterectomy and abdominal myomectomy. Formation of new leiomyomas after these conservative therapies remains a substantial problem. Although medications that manipulate concentrations of steroid hormones are effective, side-effects limit long-term use. A better approach may be manipulation of the steroid-hormone environment with specific hormone antagonists. There has been little evidence-based evaluation of therapy. New research into the basic biology of these neoplasms may add new treatment options for the future as the role of growth factors and genetic mutations in these tumours are better understood.

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Variation in the incidence of uterine leiomyoma among premenopausal women by age and race.

Brandon Marshall, Mildred M. Goldman, J Manson … (1997)

To quantify the incidence of uterine leiomyoma confirmed by hysterectomy, ultrasound, or pelvic examination according to age and race among premenopausal women. From September 1989 through May 1993, 95,061 premenopausal nurses age 25-44 with intact uteri and no history of uterine leiomyoma were followed to determine incidence rates of uterine leiomyoma. The self-reported diagnosis was confirmed in 93% of the medical records obtained for a sample of cases. Using pooled logistic regression, we estimated relative risks (RRs) of uterine leiomyoma according to race and examined whether adjustment for other potential risk factors could explain the variation in the race-specific rates. During 327,065 woman-years, 4181 new cases of uterine leiomyoma were reported. The incidence rates increased with age, and the age-standardized rates of ultrasound- or hysterectomy-confirmed diagnoses per 1000 woman-years were 8.9 among white women and 30.6 among black women. After further adjustment for marital status, body mass index, age at first birth, years since last birth, history of infertility, age at first oral contraceptive use, and current alcohol consumption, the rates among black women were significantly greater for diagnoses confirmed by ultrasound or hysterectomy (RR 3.25; 95% confidence interval [CI] 2.71, 3.88) and by hysterectomy (RR 1.82; 95% CI 1.17, 2.82) compared with rates among white women. We observed similar RRs when the cohort was restricted to participants who reported undergoing a screening physical examination within the 2 years before baseline. A higher prevalence of known risk factors did not explain the excess rate of uterine leiomyoma among premenopausal black women.

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Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy.

Robert Giuntoli, Daniel S. Metzinger, Connie S Dimarco … (2003)

We evaluated the predictive value of several proposed prognostic indicators and the effect of surgical management and adjuvant therapy on clinical outcome associated with leiomyosarcoma (LMS) of the uterus. A medical record search of patients treated at Mayo Clinic from 1976 through 1999 was performed using the International Classification of Diseases, Ninth Revision codes for LMS and malignant neoplasm of the uterus. Study inclusion criteria included confirmation of the diagnosis of LMS of the uterus by a pathologist at our institution. Survival curves were generated using the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazards model. A case-control investigation was also performed. A total of 208 patients met study requirements. The median follow-up for survivors was 7.7 years. Multivariate analysis showed that high grade, advanced stage, and oophorectomy were associated with significantly worse disease-specific survival. Case-control investigations suggested that ovarian preservation does not adversely affect survival and that adjuvant pelvic radiation therapy does not significantly improve survival. An LMS risk-assessment index that was generated is highly predictive of survival. Tumor grade and stage (using modified criteria for endometrial cancer) appear to be valid prognostic indicators for LMS of the uterus. Ovarian preservation may be considered in premenopausal patients with early-stage leiomyosarcoma of the uterus. Additionally, adjuvant therapy does not appear to significantly affect survival. Finally, our highly predictive LMS risk-assessment index may be useful for counseling patients.

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Author and article information

Journal

Journal ID (iso-abbrev): J Menopausal Med

Title: Journal of menopausal medicine

Publisher: The Korean Society of Menopause

ISSN: 2288-6478

ISSN (Print): 2288-6478

Publication date (Electronic): Dec 2013

Volume: 19

Issue: 3

Affiliations

[1 ] Kosin University Graduate School, Busan, Korea.

[2 ] Department of Obstetrics and Gynecology, Wonkwang University College of Medicine, Iksan, Korea.

[3 ] Department of Obstetrics and Gynecology, College of Medicine, Kosin University, Busan, Korea.

[4 ] Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea.

[5 ] Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea.

[6 ] Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea.

Article

DOI: 10.6118/jmm.2013.19.3.123

PMC ID: 4217555

PubMed ID: 25371877

SO-VID: 9c84f5f2-ea43-4e48-bf42-3c5fc6943522

History

Keywords: Estrogens,Myoma,Postmenopause,Progesterone,Uterus

Data availability:

Keywords: Estrogens, Myoma, Postmenopause, Progesterone, Uterus

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Effects of menopausal hormone therapy on uterine myoma in menopausal women.

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Neuropharmacology and Therapy

Most cited references 22

Uterine fibroids.

Variation in the incidence of uterine leiomyoma among premenopausal women by age and race.

Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy.

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